A Health Policy Dialogue was held in Accra, Ghana, on 26 July 2012 to identify ways in which to help Kayayei (headload porters) better access health services, and to help integrate these workers into the Ghanaian National Health Insurance Scheme (NHIS). At the Dialogue, a case study of the Ghana NHIS was presented, which showed that the Kayayei were unable to easily use the health services in Accra. A large number of Kayayei were not registered with the NHIS. Most could not afford the premium, even though the minimum annual premium is set at US$5. In practice, $15-$20 is charged as a minimum in urban areas and many Kayayei earn $2-3 or less a day, making this unaffordable for them. Those few who could afford to join complained that they were mistreated or ignored when they went to use the health services. The Ministry of Health has indicated a willingness to enter into discussions with the Kayayei associations and WIEGO on the poor quality of care received by these workers when accessing health services. Ministry of Health officials proposed that clinics and hospitals in areas where Kayayei live and work should have doctors and nurses specially mandated to look after their needs.
Equitable health services
The objectives of the Health Sector Support Project (HSSP) for Kenya, which is funded by the World Bank, are to improve: the delivery of essential health services for Kenyans, especially the poor; and the effectiveness of planning, financing and procurement of pharmaceuticals and medical supplies. There are two components to the project, the first component being effective and transparent implementation of the Kenya Essential Package for Health (KEPH) through Health Sector Services Fund (HSSF) grants and performance strengthening. The project will support the effective implementation of the KEPH, through financing the HSSF targeted at health service delivery levels one, two, and three. The HSSF aims to improve the delivery of quality essential services, especially at the sub-district and community levels, in an equitable and efficient manner, through: generating and providing sufficient resources for implementing each facility's Annual Operational Plan (AOP) to address preventive, promotive, and curative services at levels one, two, and three, and to account for them in an efficient, and transparent manner according to current government systems; and supporting capacity building in the management of health facilities. Finally, the second component is the availability of essential health commodities and supply chain management reform. This component will be implemented in parallel with the HSSF, to ensure an improved availability of commodities in, and enhance the quality of care provided at, the lower levels of the public health system.
A lack of laboratory facilities, transport and skilled medical workers is reported to be hampering efforts to tackle an outbreak of visceral leishmaniasis, a parasitic disease also known as kala azar or black fever, in northern Kenya’s Isiolo and Wajir districts, officials said. According to public health officials in the district prevention and management of the disease is limited by the availability of trained personnel.
The availability of drugs to treat two leading killer diseases in the country's public health facilities still falls below the internationally recommended benchmark, a survey shows. On average, the availability of two anti-retrovirals meant to treat HIV/Aids and that of the newly launched anti-malarial drug fell at least 10 marks below the recommended 75 per cent.
The aim of this research was to understand key issues in the functioning of two different primary care clinics serving the same community, in order to learn more about clinic management. Data were collected in a government and an NGO clinic in the North West province of South Africa. Key findings included: (i) there are attitudinal differences between the staff at the two clinics; (ii) the patients appreciate the services of both clinics, though they view them differently; (iii) clinic A provides a wider range of services to more people more often; (iv) clinic B presents a picture of quality of care, related to the environment and approach of staff; (v) waiting time is not as important as how patients are treated; (vi) medications are a crucial factor, in the minds of staff and patients; and (vii) a supportive, empowering organisational culture is needed to encourage staff to deliver better care to their patients. The management of the clinic is part of this culture. A respectful and caring approach to patients, and an organisational culture which supports and enables staff, can achieve much of this without any additional resources.
Director General of the World Health Organisation, Dr Margaret Chan, addressed the Tokyo International Conference of Africa's Development (TICAD) held in Nairobi, Kenya, in August 2016. She raised the issue of Ebola as an example of the consequences of failing to invest in the community and resilient health systems. Dr Chan noted that well-functioning health systems that cover entire populations are now regarded as the first line of defence against the threat from emerging and re-emerging diseases. Apart from strengthened health security, Africa has much to gain from its commitment to universal health coverage (UHC). For decades, the biggest barriers to better health in Africa have been weak health systems and inadequate human and financial resources. A commitment to UHC means a commitment to address these barriers. UHC also addresses a third barrier to progress of dire poverty, including poverty caused by catastrophic spending on health care. A commitment to UHC, backed by country-specific plans for implementation gives African countries a huge opportunity to leap ahead. Dr Chan offered three pieces of advice. First, to understand that UHC is a direction for a journey, not a destination. Second, use the power of robust data to shape equitable policies in line with national contexts. For example, Kenya used the results from a survey of public expenditure to launch its innovative Health Sector Services Fund that provides direct cash transfers to primary health care facilities. Third, if UHC is to work as both a poverty-reduction strategy and a boost to health security, countries need to ensure that reforms reach health systems at the district level that support impoverished communities, and are best placed to engage them in health promotion, prevention, and the delivery of services that match perceived needs.
A cross-sectional study was conducted, based on systematic sampling of consecutive patients with pulmonary tuberculosis (TB) symptoms and who attended the TB clinic for their medication at Ilala District Hospital, Tanzania. Over half the patients (54.3%) admitted that they openly speak about their illness to others but that only one-third (33.3%) of their friends and family responded in a considerate and sympathetic manner. One-third (36.6%) of the friends and relatives became less friendly and the remaining one-third openly portrayed fear and tried to discriminate the patient even after the commencement of medications. The patients' compliance rate was 100%. The counselling received from the health personnel along with the patients' own motivations to improve their health, was the main driving force in seeking treatment and taking daily medication. Discrimination against TB patients by relatives and friends is likely to hinder positive health seeking behaviour and thus impede control of this disease. This paper discusses identified areas where effort is needed to improve the early management of TB patient.
In this study, researchers assessed knowledge of tuberculosis (TB) and HIV, and perceptions about provider-initiated testing and counselling (PITC) among TB patients attending health facilities in Harar town, Eastern Ethiopia. Using a semi-structured questionnaire, a total of 415 study participants were interviewed about their knowledge of TB and HIV as well as the impact of HIV testing on their treatment-seeking behaviour. Results showed that living more than 10 km from a health facility was associated with low knowledge of TB and low knowledge of HIV testing. Delay in treatment was more likely among female participants, single participants and those living more than 10 km from a health facility. Most of the study participants (70%) believed that there was no association between TB and HIV and AIDS, while most (81.6%) of the study participants who were 21 years old or younger believed that fear of PITC could cause delay in treatment seeking. The authors recommend that emphasis should be given to improving knowledge of TB and HIV among residents living far from a health facility, as well as to improving the negative perceptions of PITC among young adults.
This paper addresses the relationship between knowledge about cervical cancer, attitudes, self-reported behavior, and immediate support system, towards screening and vaccination of cervical cancer of Zambian women and men, as a basis for improving and adjusting existing prevention programs. A cross-sectional mixed methods study was conducted with women and men residing in Chilenje and Kanyama, Zambia. Less than half of the respondents had heard of cervical cancer, 20.7% of women had attended screening and 6.7% of the total sample had vaccinated their daughter. Knowledge of causes and prevention was very low. There was a strong association between having awareness of cervical cancer and practicing screening and vaccination. Social interactions were also found to greatly influence screening and vaccination behaviors. The low level of knowledge of causes and prevention of cervical cancer suggests a need to increase knowledge and awareness among both women and men. The authors note that interpersonal interactions have great impact on practicing prevention behaviors.
NEPAD and the East African Community (EAC) launched the EAC Medicines Registration Harmonisation (MRH) Project on 30 March 2012 in Arusha, Tanzania. The EAC MRH Project will promote the harmonisation of medicines registration in the region, which is expected to allow the public health sector to rapidly access good quality, safe and effective medicines for priority diseases. The EAC Secretariat, working in close collaboration with representatives from the National Medicines Regulatory Authorities (NMRAs) of all five partner states, will implement the project. Partner states agreed to co-operate in the initial stages of the project, including drawing up the draft implementation work plan and budgets, and the draft operational manual. Stakeholders hope that successful implementation of the EAC project will serve as a model for other countries and regions considering harmonised regulations for their populations.